Healthcare Provider Details

I. General information

NPI: 1053460758
Provider Name (Legal Business Name): THUAN TRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 4TH ST
PHILADELPHIA PA
19147-5948
US

IV. Provider business mailing address

1401 S 31ST ST FL 2
PHILADELPHIA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-339-1070
  • Fax: 215-339-1080
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberME102392
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD463579
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: